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Bedeutung der Zweitmeinung bei Prostatabiopsien

Importance of second opinions on histology of prostate biopsy specimens

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Zusammenfassung

Hintergrund

Konsiliarfälle des Jahres 2008, die der Überprüfung bzw. Konkretisierung der Primärdiagnose „Prostatakarzinom“ bzw. „suspekte Prostataläsion“ durch eine Zweitmeinung („second opinion“) dienten, wurden analysiert.

Material und Methodik

Histologische Schnittpräparate von 920 Stanzbiopsien wurden mit Hämatoxylin und Eosin gefärbt und ggf. immunhistochemisch mit verschiedenen Basalzellmarkern, dem Tumormarker α-Methylazyl-CoA-Razemase (P504 S), prostataspezifischem Antigen und neuroendokrinen Markern behandelt. Karzinome wurden nach dem modifizierten Gleason-Grading klassifiziert.

Ergebnisse

Die Zweitbegutachtung suspekter Prostatabefunde ergab in 43,5% der Fälle ein Adenokarzinom. In 53,2% wurden die atypische kleindrüsige Proliferation bestätigt und weitere Kontrollen empfohlen. Eine hochgradige prostatische intraepitheliale Neoplasie wurde nur 2-mal diagnostiziert. Der Verdacht auf ein Prostatakarzinom konnte in 87,2% gesichert werden. Nach Bestätigung mikrofokaler Karzinome lagen beim Grading in 82,8% Gleason-Scores 6 und 7(3 + 4) vor, die prognostisch der günstigen Low-grade-Gruppe zuzuordnen waren. High-grade-Karzinome machten in der Diagnostik und beim Grading keine Probleme.

Schlussfolgerungen

Die Zweitmeinung bei der histologischen Diagnostik von Prostataläsionen mit Verdacht auf Malignität dient der Qualitätssicherung bei der Prostatakarzinomdiagnostik und kann bei der Wahl der weiteren Therapie wegweisend sein.

Abstract

Objective

The significance of a second opinion on the histological findings of prostate carcinomas as well as suspicious lesions on core needle biopsy specimens was studied in cases from the year 2008.

Study design

A total of 920 core needle biopsy specimens of the prostate were stained with H & E and when necessary immunohistochemical analyses were performed with basal cell markers p63, 34ßE12, PSA and AMACR (P504 S) and neuroendocrine markers such as synaptophysin and chromogranin. The modified Gleason grading system was used.

Results

In 43.5% of suspicious lesions adenocarcinomas of the prostate were found. In 53.2% the findings of atypical small acinar proliferations or high-grade prostatic intraepithelial neoplasia (HGPIN) were confirmed with a recommendation of serum PSA and morphological controls. The suspicion of prostatic carcinoma could be confirmed in 87.2% by the diagnosis of adenocarcinoma. After Gleason grading 82.8% of all diagnosed carcinomas had scores 6 or 7(3 + 4) and belonged to the group of low grade carcinomas. High grade carcinomas were without diagnostic problems.

Conclusion

A second opinion on the histological analysis of suspicious lesions of the prostate as well as of confirmation of Gleason grading is a very important point of quality management of diagnostic steps of prostate carcinomas and may be helpful for different therapeutic strategies.

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  1. Schwerpunkt Uropathologie, Institut für Pathologie, HBH-Kliniken Singen, Akademisches Lehrkrankenhaus der Universität Freiburg, Postfach 720, 78207, Singen, Deutschland

    B. Helpap & U. Oehler

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  1. B. Helpap
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  2. U. Oehler
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Correspondence to B. Helpap.

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Helpap, B., Oehler, U. Bedeutung der Zweitmeinung bei Prostatabiopsien. Pathologe 33, 103–112 (2012). https://doi.org/10.1007/s00292-011-1462-y

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